- The fever you are waiting for may never come. Corticosteroids and calcineurin inhibitors blunt fever and inflammation. New fatigue, confusion, or a single temperature of 100.4°F (38°C) is a reportable event, not a wait-and-see.
- No live vaccines — MMR, varicella, live zoster, intranasal influenza, yellow fever, oral typhoid, rotavirus. Inactivated vaccines (including the IM influenza vaccine) are given and encouraged; vaccinate before transplant whenever possible.
- Expect prophylaxis: trimethoprim–sulfamethoxazole for Pneumocystis jirovecii, valganciclovir for CMV, an antifungal for oral candidiasis. These are not optional extras.
- Labs you own: CBC with differential — watch the absolute neutrophil count (<500/mm³ is severe neutropenia); plus creatinine, potassium, magnesium, glucose, LFTs, and drug troughs. Draw troughs immediately before the next dose.
- Teaching: hand hygiene; avoid crowds and sick contacts; no raw or undercooked meat, eggs, or unwashed produce; gloves for gardening; someone else changes the cat litter; no live plants or standing water at the bedside; report sore throat, cough, or burning on urination the same day.
- Years later: skin cancer and post-transplant lymphoproliferative disorder. Daily sunscreen and an annual skin exam are part of the prescription.
Never let a patient self-discontinue. Stopping immunosuppression — even for a few doses, even because they "feel fine" — is how grafts are lost. If vomiting prevents doses, that is a call to the transplant team, not a skipped day.